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Ten-Year Follow-Up Study of PTSD Diagnosis, Symptom Severity, and Psychosocial Indices in Aging Holocaust Survivors
Abstract
We performed a longitudinal study of holocaust survivors with and without post-traumatic stress disorder (PTSD) by assessing symptoms and other measures at two intervals, approximately 10 years apart.
The original cohort consisted of 63 community-dwelling subjects, of whom 40 were available for follow-up.
There was a general diminution in PTSD symptom severity over time. However, in 10% of the subjects (n=4), new instances of delayed onset PTSD developed between time 1 and time 2. Self-report ratings at both assessments revealed a worsening of trauma-related symptoms over time in persons without PTSD at time 1, but an improvement in those with PTSD at time 1.
The findings suggest that a nuanced characterization of PTSD trajectory over time is more reflective of PTSD symptomatology than simple diagnostic status at one time. The possibility of delayed onset trajectory complicates any simplistic overall trajectory summarizing the longitudinal course of PTSD.
... They observed a significant decrease in overall PTSD symptoms, which they found to be attributable to a decrease in reexperiencing and hyperarousal symptoms, despite a significant increase in avoidance symptoms. Yehuda et al. (2009) reported similar findings for a community sample of Holocaust survivors who had not received significant prior psychiatric treatment. The authors reported a decrease in PTSD symptom severity, with a marked decrease in reexperiencing symptoms and increase in avoidance symptoms. ...
... In a review, Andrews et al. (2007) showed that delayed-onset PTSD in the absence of any prior symptoms is rare. However, if defined as an exacerbation or reactivation of prior symptoms, delayed-onset PTSD is reported frequently (e.g., Op den Velde et al., 1993;Yehuda et al., 2009). A number of reasons have been proposed for an increase in PTSD symptoms in older age. ...
... Furthermore, given the small sample sizes and limited numbers of studies available, caution is warranted in generalizing the existing data. Taking a somewhat different perspective, Yehuda et al. (2009) argued that the change in overall symptom severity is less relevant than the change in the shape of the symptom profile. In their sample of 40 Holocaust survivors, four individuals showed delayed-onset PTSD after prior symptoms within a 10-year period (Table 3). ...
... In the context of negative stimuli, alterations may exist either in the direction of hypervigilance and hyperarousal, and/or avoidance and distancing (Ehring and Quack, 2010;Litz et al., 2000). In addition, symptoms are labile over time within individuals (Galatzer-Levy and Bryant, 2013;Solomon and Mikulincer, 2006;Wu and Cheung, 2006;Yehuda et al., 2009), such that the most distressing symptoms for any one individual changes as a function of time (Yehuda et al., 2009). Owing to the heterogeneous nature of PTSD, there may therefore be significant individual variability in LPP response during down-regulation that depends on the presence of specific symptom dimensions. ...
... In the context of negative stimuli, alterations may exist either in the direction of hypervigilance and hyperarousal, and/or avoidance and distancing (Ehring and Quack, 2010;Litz et al., 2000). In addition, symptoms are labile over time within individuals (Galatzer-Levy and Bryant, 2013;Solomon and Mikulincer, 2006;Wu and Cheung, 2006;Yehuda et al., 2009), such that the most distressing symptoms for any one individual changes as a function of time (Yehuda et al., 2009). Owing to the heterogeneous nature of PTSD, there may therefore be significant individual variability in LPP response during down-regulation that depends on the presence of specific symptom dimensions. ...
After diagnosis, veterans with posttraumatic stress disorder (PTSD) display significant variability in the natural course of illness (Bonanno et al., 2012)). Cross-sectional work reveals that abnormal neural response during emotion reactivity-measured using the late positive potential (LPP)-correlates with PTSD symptom severity; however, whether the LPP during emotional reactivity and regulation predicts symptoms over time is unknown. The current study examined the LPP during emotion reactivity and regulation as predictors of PTSD symptoms over one year in OEF/OIF/OND combat-exposed veterans. At baseline, participants completed an Emotion Regulation Task (ERT) during electroencephalogram recording. The Clinician Administered PTSD Scale (CAPS) was completed at baseline (N=86), 6-months (N=54) and 1-year (N=49) later. During ERT, participants viewed negative pictures; partway through they were instructed to "reappraise" (i.e., reduce negative affect/regulate) or "look" (i.e., passively react). Change in LPP during emotional reactivity (ΔLPP-E) and reappraisal (ΔLPP-R) were calculated and used in multilevel mixed modeling to predict CAPS over time. Findings demonstrated that deficiency in reappraisal (ΔLPP-R) predicted more overall symptoms over time, while greater neural responses to emotion (ΔLPP-E) and greater change in neural response as a function of reappraisal (ΔLPP-R) predicted a decline in avoidance symptoms over time. Together, results support the utility of neural markers of emotional reactivity and regulation as predictors of PTSD symptoms-and change in symptoms-across one year.
... Една таква студија е истражувањето на Јехуда и сор. (Yehuda et al., 2009), кое опфаќа две процени во период од 10 години кај 40 преживеани од холокаустот. Биле утврдени пет траектории: отпорност, рана резилиентност, доцна резилиентност, одложен почеток и хронична сиптоматологија. ...
... Во состојба на ремисија се наоѓа секој шести испитаник, кај секој деветти испитаник е утврден релапс, а хронична траекторија на ПТСР постои кај секој шести испитаник. За слични траектории известуваат и други автори (Yehuda et al., 2009;Bonanno et al., 2012;Boscarino & Adams, 2009). Иако е утврдена една позитивна траекторија, сепак, станува збор за закрепнување по долготрајно ПТСР, што индиректно упатува на примарно слаби и/или последователно нарушени механизми за справување со доживеаната трауматизација. ...
The paper presents findings from the first prospective study that follows the course and changes in posttraumatic consequences over a period of five years in persons with long-term posttraumatic stress disorder related to the war conflict in Macedonia in 2001. The study consists of three assessments of mental health in persons diagnosed with PTSD. Data were collected with the Life Stressor Checklist-Revised, Mini International Neuropsychiatric Interview, Brief Symptom Inventory and the Impact of Event Scale-Revised. The findings confirm that the process of adaptation after cumulative traumatization is complex and has a variable course for most of the traumatized persons. Four trajectories of posttraumatic adaptation were determined: one positive (recovery), in over half of the respondents, and three maladaptive (remission, relapse and chronic PTSD trajectory) among other respondents. Confirmed risk factors for chronic trajectory of posttraumatic adaptation are lower number of experienced traumatic events prior to the first assessment, as well as increased severity of posttraumatic symptoms and comorbidity of at least two mental disorders in the second and third assessment. The expectations that certain sociodemographic variables, forced migration and increased number of experienced trauma are risk factors for chronic posttraumatic adaptation were not confirmed. Given the time distance and the social circumstances that followed the war traumatization, the findings highlight the need for interventions at the level of collective trajectories of posttraumatic adaptation, that represents the context for development and change of individual trajectories
of posttraumatic recovery.
... 3 Reactivated and/or delayedonset PTSD trajectories have also been identified in other samples of Israeli veterans, as well as Holocaust survivors. [4][5][6] However, not all studies have found evidence of long-delayed exacerbation of PTSD symptoms in veterans. 7 Thus, there is a need for population-based studies of aging veterans in order to characterize the burden of this phenomenon, as previously reported prevalence estimates have been ascertained from selected trauma-exposed samples and may not be representative. ...
... It is illegal to post this copyrighted PDF on any website. 26 Items summed (range, [3][4][5][6][7][8][9] Cognitive difficulties Assessed using the MOS Cognitive Functioning Scale-Revised. 27 Items were reverse scored and summed so that higher scores reflect greater cognitive dysfunction Community integration Assessed using the item, "I feel well integrated in my community (eg, regularly participate in community activities)" (range, 1-7) ...
Objective: More than 60% of US military veterans are 55 years or older. Although several case studies have suggested that older age is associated with a higher likelihood of reactivated or delayed-onset posttraumatic stress disorder (PTSD) symptoms in veterans, population-based data on the prevalence and determinants of this phenomenon are lacking. Method: Using data from the National Health and Resilience in Veterans Study (NHRVS: Wave 1 = October 2011–December 2011; Wave 2 = September 2013), a nationally representative, cohort study of US veterans, we evaluated the prevalence and determinants of exacerbated PTSD symptoms in 1,441 veterans 55 years or older using a DSM-IV– based measure in 2011 and a DSM-5–based measure in 2013. Veterans whose worst trauma occurred at least 5 years prior to Wave 2 of the NHRVS (mean = 28.6 years) and who reported a clinically significant increase (ie, ≥ 0.5 standard deviation [SD]; mean = 1.27, SD = 0.78) in PTSD symptoms from Wave 1 (lifetime) to Wave 2 (past-month) were identified as having exacerbated PTSD symptoms. Results: Results revealed that 9.9% of older US veterans experienced exacerbated PTSD symptoms an average of nearly 3 decades after their worst trauma. A multivariable logistic regression model indicated that greater self-reported cognitive difficulties at Wave 1 independently predicted exacerbated PTSD symptoms at Wave 2. Post hoc analysis revealed that this association was driven by greater severity of executive dysfunction (adjusted odds ratio range, 1.27–3.22). Conclusions: Approximately 1 in 10 older US veterans experiences a clinically significant exacerbation of PTSD symptoms in late life. Executive dysfunction may contribute to risk for exacerbated PTSD symptoms. These results suggest that exacerbated PTSD symptoms are prevalent in US veterans and highlight potential targets for identifying veterans at risk for this phenomenon.
... Die grössere Anzahl von Holocaust-Überlebenden erleben im Laufe ihres Lebens eine langsame Abnahme von PTBS-Symptomen, wobei die Wiedererlebens-Symptome seltener werden, dagegen die Vermeidungssymptome häufiger (Trappler, Braunstein, & Moskowitz, 2002;Yehuda, et al., 2009). Jedoch nehmen in ca. ...
... Jedoch nehmen in ca. 10% der Holocaust-Überlebenden die Symptome über die Jahre zu oder werden nach einem langen symptomfreien Intervall reaktiviert (Yehuda, et al., 2009). Obwohl, wie eben zusammengefasst, Überlebende einen unglaublichen Adaptationsprozess zeigen, stellt das Altern neue Herausforderungen für diesen Adaptationsprozess dar. ...
Viele Holocaust-Überlebende zeigen im Alter mehr Symptome einer Posttraumatischen Belastungsstörung (PTBS), Angst- und depressiven Störung. Etablierte Behandlungsansätze der PTBS wie die prolongierte und narrative Expositionstherapie, die kognitiven Therapien und die psychodynamischen Therapien wurden besonders bei Kindern und (jungen) Erwachsenen evaluiert, kaum jedoch bei älteren Patienten. In der Alterspsychotherapie gehört die Lebensrückblicktherapie zu den wirksamsten Behandlungsformen einer Depression. Auf diesem Hintergrund wird eine Form der Lebensrückblicktherapie beschrieben, die narrative Exposition und kognitive Techniken integriert und dadurch eine altersadäquate Behandlungsform von Holocaust-Überlebenden darstellt. Ebenfalls werden Unterschiede zu einem Lebensrückblick im Rahmen einer psychodynamischen Therapie beschrieben und es wird eine Studie vorgestellt, die die Wirksamkeit der Lebensrückblicktherapie und der psychodynamischen Therapie vergleicht.
... Our remission estimate was more comparable to the rate found among terrorist attack survivors (33.1%) [32], survivors of serious physical illnesses (e.g., myocardial infarction, hemorrhage, or cancer) (28.6-31.4%) [33][34][35], holocaust survivors (30%) [36] or in studies involving diverse traumatic events including unwanted sex, assault, or witnessing someone being injured or killed (38%) [37]. At the same time, our rates were higher than found in a study of victims of motor vehicle injuries (13%) [38] or industrial accidents (16.7%). ...
This study examines differences in a nationally representative sample, in proportions of men and women with lifetime diagnoses of Posttraumatic Stress Disorder (PTSD) who achieved diagnostic remission and gender-specific correlates. Data from the 2012-13 National Epidemiologic Survey on Alcohol and Related Conditions-III included 1,997 adults with a lifetime PTSD diagnosis (70.8% female and 29.2% male). Of these 25.3% of women and 24.3% of men experienced remission (ns). Women who remitted were older than other women, more likely to be retired, and less likely to report disability, past homelessness, suicide attempts, criminal history, violent behavior, or parental histories of drug problems or suicide. Men who remitted were less likely than other men to be separated/divorced, disabled, incarcerated after age 15, and reported fewer violent behaviors. Remission was significantly more strongly associated among women than men with greater age, emergency room visits, trauma and less with schizotypal personality. Although women were twice as likely to be diagnosed with PTSD, there were no significant gender differences in the proportions who experienced remission. Remission was associated with diverse sociodemographic and clinical disadvantages among both men and women but only four were statistically significantly different between genders.
... While the PTSD-diagnosis of P1 was mainly characterized by avoidance behavior (eFigure 1), patient 2 predominantly suffered from intrusive symptoms, hyperarousal, negative cognitions/negative mood as well as from functional impairment in several life domains (eFigure 2). In a ten-year follow-up study of PTSD in aging HS, Yehuda (2009) found stable intrusive symptoms, while avoidance and hyperarousal symptoms "were more reflective of current state" (p. 31). ...
Having reached the last phase of their lives, many Holocaust survivors (HS) experience an increase in vulnerability. Despite their remarkable ability to adapt, the process of aging presents them with new challenges, often leading to an increased need for therapy. This is made all the more difficult by the fact that there is little research on trauma therapy in old age. To date, no randomized controlled study has been carried out to examine the effectiveness of psychotherapy in HS. The present case studies report the implementation of life review therapy (LRT-HS) undertaken with two female HS with symptoms of post-traumatic stress disorder (PTSD). The mixed-methods approach sheds light to their individual therapy courses and potential mechanisms of change. Both therapies took place in the context of a randomized controlled study evaluating the efficacy of LRT-HS. This integrative, narrative therapy approach answers the natural need of elderly people to look back on their lives. Patients received about 20 sessions of LRT-HS, including a structured life review, narrative exposure, as well as cognitive and behavioral elements. Patient 1 showed reliable to clinically significant improvements on several quantitative symptom levels and with consistent qualitative findings (e.g., semistructured therapist interview). Symptoms of Patient 2 remained mostly unchanged, while life satisfaction and posttraumatic growth reliably improved and qualitative measures pointed to a reduction of suffering. The studies illustrate that reminiscence can be used in adaptive ways even after the experience of massive traumatization. The coexistence of resilience and vulnerability, complex individual symptom profiles, and influencing factors are discussed.
... We saw a decrease in the predictive significance of PTSS in relation to more distant symptoms, with wave 3 symptoms showing the highest importance in predicting wave 4 PTSS, followed by wave 2 and wave 1 symptoms. The higher importance of recent vs. more distant PTS symptoms in predicting future PTSS is consistent with a previous study that reported a general diminution in PTSD symptom severity over time (Yehuda et al., 2009). We also found prior depression and anxiety as significant predictors for PTSS risk, consistent with a prior ML study (Schultebraucks et al., 2020), which showed pre-deployment depression and anxiety as risk factors for PTSD in army personnel deployed to Afghanistan. ...
Background
A range of factors have been identified that contribute to greater incidence, severity, and prolonged course of post-traumatic stress disorder (PTSD), including: comorbid and/or prior psychopathology; social adversity such as low socioeconomic position, perceived discrimination, and isolation; and biological factors such as genomic variation at glucocorticoid receptor regulatory network (GRRN) genes. This complex etiology and clinical course make identification of people at higher risk of PTSD challenging. Here we leverage machine learning (ML) approaches to identify a core set of factors that may together predispose persons to PTSD.
Methods
We used multiple ML approaches to assess the relationship among DNA methylation (DNAm) at GRRN genes, prior psychopathology, social adversity, and prospective risk for PTS severity (PTSS).
Results
ML models predicted prospective risk of PTSS with high accuracy. The Gradient Boost approach was the top-performing model with mean absolute error of 0.135, mean square error of 0.047, root mean square error of 0.217, and R² of 95.29%. Prior PTSS ranked highest in predicting the prospective risk of PTSS, accounting for >88% of the prediction. The top ranked GRRN CpG site was cg05616442, in AKT1, and the top ranked social adversity feature was loneliness.
Conclusion
Multiple factors including prior PTSS, social adversity, and DNAm play a role in predicting prospective risk of PTSS. ML models identified factors accounting for increased PTSS risk with high accuracy, which may help to target risk factors that reduce the likelihood or course of PTSD, potentially pointing to approaches that can lead to early intervention.
Limitation
One of the limitations of this study is small sample size.
... We saw a decrease in the predictive significance of PTSS in relation to more distant symptoms, with wave 3 symptoms showing the highest importance in predicting wave 4 PTSS, followed by wave 2 and wave 1 symptoms. The higher importance of recent vs. more distant PTS symptoms in predicting future PTSS is consistent with a previous study that reported a general diminution in PTSD symptom severity over time (R. Yehuda et al., 2009). We also found prior depression and anxiety as significant predictors for PTSS risk, consistent with a prior ML study (Schultebraucks et al., 2020), which showed pre-deployment depression and anxiety as risk factors for PTSD in army personal deployed to Afghanistan. ...
Background
A range of factors have been identified that contribute to greater incidence, severity, and prolonged course of post-traumatic stress disorder (PTSD), including: comorbid and/or prior psychopathology; social adversity such as low socioeconomic position, perceived discrimination, and isolation; and biological factors such as genomic variation at glucocorticoid receptor regulatory network (GRRN) genes. This complex etiology and clinical course make identification of people at higher risk of PTSD challenging. Here we leverage machine learning (ML) approaches to identify a core set of factors that may together predispose persons to PTSD.
Methods
We used multiple ML approaches to assess the relationship among DNA methylation (DNAm) at GRRN genes, prior psychopathology, social adversity, and prospective risk for PTS severity (PTSS).
Results
ML models predicted prospective risk of PTSS with high accuracy. The Gradient Boost approach was the top-performing model with mean absolute error of 0.135, mean square error of 0.047, root mean square error of 0.217, and R ² of 95.29%. Prior PTSS ranked highest in predicting the prospective risk of PTSS, accounting for >88% of the prediction. The top ranked GRRN CpG site was cg05616442, in AKT1 , and the top ranked social adversity feature was loneliness.
Conclusion
Multiple factors including prior PTSS, social adversity, and DNAm play a role in predicting prospective risk of PTSS. ML models identified factors accounting for increased PTSS risk with high accuracy, which may help to target risk factors that reduce the likelihood or course of PTSD, potentially pointing to approaches that can lead to early intervention.
... The fourth main finding is that 27% of patients with BPD who did not meet criteria for PTSD at baseline later developed a new onset of PTSD. Our rate of new onsets is about three times that found in a longitudinal study of holocaust survivors over 10 years (10%) (24). It is also about five times the rate of new onsets of PTSD found in a sample of Vietnam veterans followed for 14 years (5.2%) (25). ...
... Since then, the aforementioned "delayed reaction" phenomenon in trauma came under investigation, and has been discussed, by many researchers (Bistoen et al., 2014;Fassin & Rechtman, 2009;Luckhurst, 2008;Young, 1995). Similarly, a number of empirical studies, which were carried out in this field, also endorsed the value of the deferred action (Andrews et al., 2007;Berninger et al., 2010;Bistoen et al., 2014;Carty et al., 2006;Yehuda et al., 2009). Moreover, a comprehensive analysis came to the conclusion that, on average, 38.2% and 15% of post-traumatic stress disorder (PTSD) cases in military and civilian samples, respectively, have proved to come up with delayed reactions after they were hit by trauma (Andrews et al., 2007). ...
As non-literary accounts of post-traumatic stress disorder victims depict, and contribute to, history and memory, the present study uses the theoretical underpinnings of the psychological trauma theory to reflect on the flashbacks of Afghan trauma survivors, portrayed in the selected Afghan Anglophone fiction. The research project attempts to see how far the flashbacks of the traumatic memories of these characters contribute to the oft-quoted factual history. Borrowing from Caruth, Herman, Tal and LaCapra for the analysis, the study investigates the selected literary text to see how cultural productions from this war-torn country keep a record of the traumatic memories of the war that the Afghans were faced with during the Soviet invasion from 1979 to 1989. This trauma analysis of Atiq Rahimi’s Earth and Ashes (2002) shows that analyses of trauma-induced flashbacks in literary portrayals of traumatized characters may, simultaneously, contribute to the officially recorded history of the actual event of trauma. The study concludes that related literary texts may be studied in conjunction with factual historical documents to get a holistic picture of any traumatic event as well as the related memory.
... However, veterans that developed PTSD following their first traumatic event had smaller left hippocampal volumes compared to veterans developed PTSD after exposure to multiple traumatic events. Also, veterans with PTSD had significantly lower urinary cortisol levels and diminished memory performance when compares to veterans without PTSD [24]. ...
... However, veterans that developed PTSD following their first traumatic event had smaller left hippocampal volumes compared to veterans developed PTSD after exposure to multiple traumatic events. Also, veterans with PTSD had significantly lower urinary cortisol levels and diminished memory performance when compares to veterans without PTSD [24]. ...
... The mental health of Holocaust survivors is in average still worse today than a comparison group, mainly with regard to PTSD symptoms, depression and anxiety [2]. The majority of Holocaust survivors show a chronic course, i.e. they experience a steady decrease of PTSD symptom severity, whereas about 10% of survivors show a delayed course, i.e. symptoms increase over time or get reactivated after a long symptom-free time [3]. ...
Background:
The Holocaust was one of the most traumatic catastrophes in recorded human history. Survivors seeking psychotherapeutic help today, now in their seventies and older, often show symptoms of a posttraumatic stress disorder (PTSD), depression, or prolonged grief disorder. Established psychological treatments for PTSD (e.g. cognitive behaviour therapy, psychodynamic therapies) have been tested and assessed mainly with young and middle-aged adults; only very few studies examined them in old age. There is no therapy outcome study known to us for any treatment mode for Holocaust survivors. Moreover, there is a need for an age group-specific treatment of PTSD and other stress-related mental disorders. A narrative approach including life-review and narrative exposure seems to meet very well the natural need of older people to review their lives and is highly effective. However, most studies on the efficacy of life review therapy (LRT) focus on late-life depression. There is a lack of efficacy studies evaluating the effect of LRT on PTSD symptoms in older individuals that have experienced traumatic events.
Methods:
The main goal of this study is to evaluate the effect of LRT for Holocaust survivors (LRT-HS) on symptoms of PTSD and related mental health problems (depression, anxiety, prolonged grief), compared to a supportive control group. A secondary goal is to identify the characteristics of participants that seem to especially benefit from the treatment. The proposed study is a randomised, controlled follow-up trial including Holocaust survivors with one or more trauma-related disorders. The LRT treatment consists of 20-25 sessions. Before and after the treatment phase, participants in both conditions will be assessed. Follow-up will take place 6 months after the treatment. A sample size of 80 is required (drop-out rate included).
Discussion:
Efficacious treatments for trauma-related disorders in older people are of high importance, also because the probability of traumatisation and loss increases with age. Because this study is conducted with this specific group of multiply traumatised people, we are convinced that the results can easily transfer to other samples.
Trial registration:
ISRCTN, ISRCTN12823306. Registered 31 March 2018 - Retrospectively registered (first participant 22 December 2017).
... Indeed, data collected from the administrative databases of the Veterans Health Administration (VHA) mark a persistent increase in the number of Vietnam veterans treated for PTSD 30 years following the war, indicating an increase of 37% from 2005 to 2010 (Hermes, Rosenheck, Desai, & Fontana, 2012). In contrast, some studies report a trend of diminution in PTSD symptom severity among aging trauma survivors (Yehuda et al., 2009). Hence, the assessment of PTSD trajectories across survivors' life spans, up to and including their transitions into old age, is needed. ...
Objective:
Long-term trajectories of posttraumatic stress disorder (PTSD) may fluctuate over time and typically conform to four heterogeneous patterns: resilience, recovery, delayed-onset, and chronic symptomatology. However, such fluctuations are typically short ranged and have rarely been investigated over the course of decades after the trauma. Moreover, existing studies have used a variety of measurements, either employing a categorical Diagnostic and Statistical Manual of Mental Disorders (DSM)-oriented approach or a continuous measure of symptom severity. The aim of this study was to evaluate the two methods of analyzing trajectories of PTSD by examining the level of concordance between them, their sensitivity, and their validity.
Method:
A total of 349 Israeli veterans from the 1973 Yom Kippur War were examined at four time points over more than four decades since the war. A latent class growth analysis (LCGA) was conducted to identify different PTSD trajectories, using both categorical and continuous PTSD assessments.
Results:
Descriptive results revealed that the four commonly observed patterns of PTSD are insufficient for capturing the range of individual PTSD trajectories. Using a categorical measure in the explorative LCGA yielded three trajectories (resilient, chronic, and delayed onset). The continuous measure yielded five trajectories (resilient, chronic, recovered, and two delayed-onset trajectories), which provided a slightly more nuanced distinction of participants' distress-induced psychosocial dysfunction as compared to the three-trajectory solution.
Conclusion:
These findings suggest that using a continuous PTSD trajectory measure provides a somewhat more sensitive estimation of PTSD trajectories. More specifically, taking into consideration symptom intensity and fluctuation over time may provide a more comprehensive picture of the survivors' distress.
... similar instance of subgroups of participants who revealed trajectories of delayed onset of symptoms of PTSD over a time frame of 10 years (Yehuda et al., 2009). This is the first study to date that establishes a similar pattern based on trajectories of depressive symptoms following the trauma of war captivity. ...
This longitudinal study assesses the trajectories of depressive symptoms and subjective age and the mediating role of guilt in the association between them. Two groups of aging Israeli combat veterans ( age = 57), 128 ex-prisoners of war (ex-POWs), and 106 comparable combat veterans (controls), were assessed at 3 times: 18 (Time 1 [T1]), 30 (Time 2 [T2]), and 35 (Time 3 [T3]) years after the war. They filled out self-report questionnaires on depression, guilt, and subjective age. Results revealed that significantly more ex-POWs had chronic or delayed clinical levels of depressive symptoms than did controls and that chronic and delayed depressive symptoms were associated with a higher subjective age at T3. Furthermore, the path between depressive symptoms at T1 for predicting subjective age at T3 was fully explained by levels of guilt-distress at T2. Although the mediation effect was found in both study groups, it was significantly stronger among ex-POWs than among controls. These findings suggest that not only is depression a long-term sequela of traumatic stress, it is also a risk factor for psychological aging among war veterans. Furthermore, guilt-distress appears to play an important role in advancing subjective age, especially among ex-POWs. (PsycINFO Database Record
... Die bisherigen Befunde sind inkonsistent, deuten aber darauf hin, dass das schmerzhafte Wiedererleben eher abnimmt, während die Vermeidung von traumarelevanten Reizen zunimmt (Böttche et al., 2011). Yehuda et al. (2009) betonen, dass nicht die Veränderungen in der Symptomschwere, sondern die veränderten Symptomprofile von Bedeutung sind. Möglicherweise ist gerade darin eine wesentliche Besonderheit in dieser Zielgruppe zu sehen, die in der Diagnostik und Behandlung Beachtung finden sollte. ...
... With the possibility of a symptom change over the lifespan, posttraumatic symptoms could also change from ''typical'' PTSD symptoms to somatoform disorders or other trauma-related mental health problems (Freitag, Braehler, Schmidt, & Glaesmer, 2013; Noll-Hussong et al., 2012) and also more somatic health problems may be present in older age (Glaesmer, Brähler, Gundel, & Riedel-Heller, 2011; Pietrzak, Goldstein, Southwick, & Grant, 2012). Therefore, a differentiated analysis of symptom profiles seems more informative than the investigation of overall symptom severity (Yehuda et al., 2009). ...
Background:
The proposal for ICD-11 postulates major changes for posttraumatic stress disorder (PTSD) diagnosis, which needs investigation in different samples.
Aims:
To investigate differences of PTSD prevalence and diagnostic agreement between ICD-10 and ICD-11, factor structure of proposed ICD-11 PTSD, and diagnostic value of PTSD symptom severity classes.
Method:
Confirmatory factor analysis and latent profile analysis were used on data of elderly survivors of childhood trauma (>60 years, N=399).
Results:
PTSD rates differed significantly between ICD-10 (15.0%) and ICD-11 (10.3%, z=2.02, p=0.04). Unlike previous research, a one-factor solution of ICD-11 PTSD had the best fit in this sample. High symptom profiles were associated with PTSD in ICD-11.
Conclusions:
ICD-11 concentrates on PTSD's core symptoms and furthers clinical utility. Questions remain regarding the tendency of ICD-11 to diagnose mainly cases with severe symptoms and the influence of trauma type and participant age on the factor structure.
... Evidence suggests that some PTSD symptoms are more prominent in older adults with PTSD than in younger adults with PTSD. For instance, some authors suggested that older adults with PTSD experience more symptoms of avoidance and numbing (Trappler et al., 2002;Yehuda et al., 2009) as well as more chronic disease, physical disability, and recent health problems than do younger adults with PTSD. Each of these factors or their combination might contribute more to the prediction of PTSD in older relative to younger adults (Böttche at al., 2015). ...
Objectives: The present study investigates the applicability of the behavioral model of health service use (Andersen, 1995) to the predicting of psychotherapy use among older adults.
Methods: Sample was obtained, using a random-digit dialing methodology, from the older Jewish population in Israel. The final sample consisted of 509 respondents with an average age of 74.08 (SD = 5.89). The telephone interviews were conducted in the first week of August 2011, by experienced interviewers, in Hebrew or Russian, using a structured questionnaire.
Results: After adjusting for age, gender, education, marital status, religiosity, health status, and economic status in the first step, binary logistic regression revealed that higher depressive symptoms, positive attitudes toward psychological treatment, primary physician referral, and accessibility of psychological services were all related to higher odds ratios for seeking psychological treatment.
Conclusions: The present study integrated previously identified precursors of mental health service use into one model predicting psychotherapy use among community-dwelling older adults. The model suggests that the point of entry to psychotherapy is not limited to one source and that individuals’ need, their attitudes, accessibility of services, and their primary physicians’ referral are all useful facilitators of psychotherapy use.
... Evidence suggests that some PTSD symptoms are more prominent in older adults with PTSD than in younger adults with PTSD. For instance, some authors suggested that older adults with PTSD experience more symptoms of avoidance and numbing (Trappler et al., 2002;Yehuda et al., 2009) as well as more chronic disease, physical disability, and recent health problems than do younger adults with PTSD. Each of these factors or their combination might contribute more to the prediction of PTSD in older relative to younger adults (Böttche et al., 2015). ...
Abstract
The definition of post-traumatic stress disorder (PTSD) changed in the fifth edition of the Diagnostic and Statistical Manual (DSM-5) and it is yet unclear how these changes affect the diagnosis of PTSD among older adults. The present study examined the contribution of demographic characteristics, functioning status, health related factors, as well as exposure to rocket attacks to prediction of probable PTSD in older adults. Three-hundred and thirty-nine community-dwelling adults (age range 50-90; M=65.44, SD=9.77) were sampled through random dialing to Jewish residents in the south of Israel. Participants completed a phone-questionnaire that collected background information and reports of relevant symptoms. Analyses showed that self-rated health, incidence of depression episodes, and exposure to rocket attacks predicted the DSM-5 definition of PTSD as well as the subscale of negative alternations in cognition and mood. The current study delineates the unique set of predictors of probable PTSD in older adults, with an emphasis on negative alternations in cognition and mood. Greater attention to unique predictors of PTSD in the second half of life is called for.
Keywords: PTSD, DSM-5, negative alternations in cognition and mood, older adults
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... However, veterans that developed PTSD following their first traumatic event had smaller left hippocampal volumes compared to veterans developed PTSD after exposure to multiple traumatic events. Also, veterans with PTSD had significantly lower urinary cortisol levels and diminished memory performance when compares to veterans without PTSD [24]. ...
... 108 A subgroup of older adults, however, experience delayed-onset symptoms, with symptoms of increasing avoidance and hyperarousal as they age. 109 Poor physical health is associated with late-life-onset PTSD and is a risk factor for developing more physical and mental illnesses. 107 More research is needed to clarify the nature of PTSD in the elderly. ...
Anxiety disorders are highly prevalent among the elderly and are associated with increased disability, poor quality of life, and cognitive impairment. Despite this high prevalence and associated morbidities, anxiety disorders in late life are underreported and understudied. In this article, we discuss the epidemiology, disease presentation, and current treatment of anxiety disorders in older adults. We also discuss limitations in the current understanding of such disorders in this population, as well as future research directions that may reveal the mechanisms and rationale for treatment regimens for anxiety disorders in late life. We present material on the application of the Research Domain Criteria (RDoC) model to geriatric anxiety. Finally, we describe optimal management strategies of anxiety disorders.
... For those who experienced traumatic events, the development of subsequent trauma-related psychiatric symptoms may be quite varied (Lapp et al., 2011;Solomon, Horesh, Ein-Dor, & Ohry, 2012;Yehuda et al., 2009). Most adults have experienced a traumatic event but never develop PTSD (Macleod, 1994). ...
Combat is a risk factor for posttraumatic stress disorder (PTSD); however, less is known about how exposure to combat in early adulthood may contribute to the development of PTSD as the individual ages. Prior exposure to trauma may "sensitize" people to respond more intensely to subsequent stressors. Further, aging initiates new challenges that may undermine previous coping strategies. Over the life course combat veterans may be more reactive to new stressors and thus be more vulnerable to PTSD.
This study draws on the two waves of the National Comorbidity Survey (NCS-1) and NCS-2 (10-year follow-up). Participants were male (noncombat N = 620 and combat N = 107) and 50-65 years of age at Wave-2. At baseline, participants were assessed for exposure to wartime combat, number of Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses in the past year, and life-time PTSD. At follow-up, PTSD occurring between waves was determined. A measure of recent life stressors was also obtained.
Using logistic regression analyses, combat predicted PTSD at follow-up (controlling for baseline demographics, number of DSM diagnoses in the past year, life-time PTSD). Recent life stressors were also associated with PTSD. Importantly, the effect of combat on PTSD was significant at high levels, but not low levels, of recent life stress.
Veterans who have experienced combat may be more reactive to new stressors, and in turn be more vulnerable to PTSD. Combat veterans should be regularly assessed for current stressors and PTSD.
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... Clinician Administered PTSD scale-CAPS, Structured Clinical Interview for DSM IV-SCID). This lack of congruency in the assessment of symptoms has been partially attributed to the wider range of symptoms that can be self-reported, compared to the fixed range of symptoms listed in the diagnosis criteria (Yehuda, et al, 2009). ...
... Concurrent evidence was reported in studies with Holocaust survivors (Freyberger and Freyberger, 2007) and expolitical prisoners (Maercker et al., 2012): Only 11% and 15%, respectively, reported avoidance behavior. However, conflicting evidence stems from other studies indicating that avoidance symptoms can increase in the course of the disorder (e.g., Trappler et al., 2002;Yehuda et al., 2009). A recent review provides evidence that overall symptom severity diminishes over the life span; however, studies are partially contradictory and evidence remains inconclusive (Böttche et al., 2012). ...
Avoidance of trauma-related stimuli is a key feature of Posttraumatic Stress Disorder (PTSD). However, avoidance has almost exclusively been investigated with explicit measures targeting more strategic aspects of behavior. The aim of the present study was to examine automatic avoidance in older individuals displaced as children at the end of World War II with (n=22) and without PTSD (n=26) and in non-traumatized control participants (n=23) with an Approach-Avoidance Task (AAT). Participants were instructed to respond to the color (gray, brown) of trauma-related, neutral, and control pictures by pushing or pulling a joystick. Groups did not differ significantly as to their behavioral tendencies towards trauma-related pictures. Thus, there was no evidence for automatic avoidance in individuals with PTSD. However, high vigilance was associated with stronger implicit avoidance towards trauma-related pictures in the PTSD group. Several explanations for the non-significant results as well as implications and limitations of the present findings are discussed.
Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
... DSM-IV defines delayed-onset PTSD as the development of the clinical syndrome 6 months or more after the traumatic event, although the evidence base for this cut-off was negligible (Carty, O'Donnell, & Creamer, 2006). The phenomenon of a "delayed reaction" to trauma has been described as a core feature of traumatic pathology throughout its entire history (Fassin & Rechtman, 2009;Luckhurst, 2008;Young, 1995), and contemporary empirical studies have also confirmed the importance of this phenomenon (Andrews, Brewin, Philpott, & Stewart, 2007;Berninger et al., 2010;Carty et al., 2006;Yehuda et al., 2009). A systematic review concluded that, on average, 38.2% and 15% of PTSD cases are delayed in military and civilian samples respectively (Andrews et al., 2007). ...
The Freudian concept of Nachträglichkeit is central to the psychoanalytical understanding of trauma. However, it has not received much attention within the contemporary field of trauma studies. This paper attempts to reconstruct the logic inherent to this concept by examining Freud’s remarks on the case of Emma. Furthermore, it is argued that Nachträglichkeit offers an interesting perspective on both (a) the well-established yet controversial finding that traumatic reactions sometimes follow in the wake of non-Criterion A events (so-called minor stressors or life events) and (b) the often-neglected phenomenon of delayed-onset PTSD. These two phenomena will appear to be related in some instances. Nachträglichkeit clarifies one way in which traumatic encounters are mediated by subjective dimensions above and beyond the objective particularities of both the event and the person. It demonstrates that the subjective impact of an event is not given once and for all but is malleable by subsequent experiences.
... It may be the case that our study sample may be a particularly resilient subgroup of refugee families and that people with more severe PTSD had died before the study was undertaken or suffered from diseases severe enough to prevent them from participating. In addition, it has been described that PTSD symptoms in ageing subjects with chronic PTSD fluctuated over long periods (Yehuda et al., 2009), which could have also influenced the intergenerational transmission of PTSD in our sample. Furthermore, the examination of a third group of non-traumatized participants born in Germany would give interesting additional information about the differential impact of flight on the next generation. ...
Intergenerational transmission of psychological trauma and the impact of parental post-traumatic stress disorder (PTSD) on offspring are controversially discussed. We studied 50 offspring (36 women and 14 men, mean age 42.1 years) of refugees who were severely traumatized as children at the end of World War II. From these, 25 of the refugees currently suffered from chronic PTSD, and 25 had no PTSD. Parental PTSD status did not significantly influence mental health [as per the Symptom Checklist (SCL)-90-R] or quality of life (assessed by the 36-item Short-form Health Survey) in their children. In the entire sample, frequency of talking with the mother about the flight correlated with phobic anxiety (r = 0.67, p = 0.03). Interestingly, the stated burden of having a parent with a history of flight significantly (p < 0.05) correlated with almost all subscales of the SCL-90-R. These results in a non-clinical sample do not support a specific role of parental PTSD in intergenerational trauma transmission. Our other remarkable, but preliminary, results need to be studied in larger samples using more subtle interaction or schema analyses. Copyright © 2014 John Wiley & Sons, Ltd.
Este artículo estudia el marco jurídico y la jurisprudencia de la Corte Penal Internacional sobre el daño transgeneracional. Fue elaborado mediante búsqueda, selección y análisis de la jurisprudencia de ese Organismo, con el objetivo de acercarnos a la forma como ha sido abordada esta modalidad de daño en perjuicio de posibles víctimas. Hasta el momento, este concepto sigue en debate jurídico y deberá ser precisado por la Corte para su uso en próximos casos, lo que deja abierta la posibilidad de reconocer este daño y el subsecuente derecho de reparación a las víctimas afectadas por crímenes juzgados y sancionados por esta.
Anxiety disorders belong to the most common mental health diagnoses in older adults. One of the cognitive-behavioral treatment approaches for late-life anxiety disorders is exposure therapy. This chapter discusses several characteristics of older adults that are important to consider when using exposure therapy with this population, including physical and cognitive changes, content of fears and worry, and chronicity of anxiety disorders. When preparing older adults for exposure, comorbid disorders must be considered in order to stabilize the patient and their symptoms; psychoeducation should be sensitive to cognitive decline; and activating and practicing resources is a helpful prerequisite. Adaptations of the procedure of exposure sessions are described for fear of falling, fear of memories in PTSD (prolonged and narrative exposure), and fear of thoughts in GAD. General adaptations include the distinction between avoidance and adequate caution, monitoring the physiological arousal, gradual exposure, and creativity in the treatment. To illustrate, a case study is provided.KeywordsOld ageOlder adultsElderlyVeteransPhysical declineCognitive declineProlonged exposureNarrative exposureIn vivo exposureImaginal exposure
While trauma sequelae in younger people have increasingly become the focus of clinical and scientific interest in recent decades, knowledge about the extent and consequences of trauma in older people remains limited. Most psychotraumatological studies to date have either not included enough older people to be able to assess age effects or have concentrated exclusively on younger study participants. This is problematic insofar as the current state of knowledge indicates that both age-specific developmental tasks or stressors and collective, generation-specific trauma contribute to a specific development and processing of trauma sequelae and especially post-traumatic stress disorder (PTSD) in old age. The chapter presents typical stressors that can affect older people to a very different extent.
Background
Firefighting has been associated with posttraumatic stress disorder (PTSD) and other mental health conditions. We previously found that among Fire Department of the City of New York (FDNY) responders to the World Trade Center (WTC) disaster, higher-intensity WTC-exposure predicted PTSD symptoms, depressive symptoms, and subjective cognitive concerns. The present study aims to compare these symptoms in the FDNY WTC-exposed cohort versus a comparison cohort of non-FDNY, non-WTC-exposed firefighters.
Methods
The study population included WTC-exposed male firefighters from FDNY (N = 8466) and non-WTC-exposed male firefighters from Chicago (N = 1195), Philadelphia (N = 770), and San Francisco (N = 650) fire departments who were employed on 9/11/2001 and completed a health questionnaire between 3/1/2018 and 12/31/2020. Current PTSD symptoms, depressive symptoms, and subjective cognitive concerns were assessed via validated screening instruments. Multivariable linear regression analyses stratified by fire department estimated the impact of covariates on each outcome.
Results
Adjusted mean PTSD symptom scores ranged from 23.5 ± 0.6 in Chicago firefighters to 25.8 ± 0.2 in FDNY, and adjusted mean depressive symptom scores ranged from 7.3 ± 0.5 in Chicago to 9.4 ± 0.6 in Philadelphia. WTC-exposure was associated with fewer subjective cognitive concerns (β = −0.69 ± 0.05, p < .001) after controlling for covariates. Across cohorts, older age was associated with more cognitive concerns, but fewer PTSD and depressive symptoms.
Conclusions
WTC-exposed firefighters had fewer cognitive concerns compared with non-WTC-exposed firefighters. We were unable to estimate associations between WTC exposure and PTSD symptoms or depressive symptoms due to variability between non-WTC-exposed cohorts. Longitudinal follow-up is needed to assess PTSD, depressive, and cognitive symptom trajectories in firefighter populations as they age.
The topic of trauma and aging has been studied more frequently in the recent past from the perspective of the consequences of early trauma experiences, especially in the context of war experiences. However, trauma can also occur later in life and have lasting consequences into older age. The study presented here assumed that these consequences can also manifest themselves in an impairment of mentalization ability. It examined a sample of patients between 40 and 80 years of age from a psychosomatic clinic (N = 150) was examined with the Essen Trauma Inventory (ETI) and two mentalization instruments. Results show that, as age increased, stressful events in adulthood correspond with impairment in mentalization ability in old age. Regarding posttraumatic symptomatology, the influence of intrusions increased as age increased. Finally, the results are discussed in a theoretical and therapeutic context.
Social traumas don"t affect not only on the survivals but also next generations directly or indirectly. The generations which are affected by the trauma have some psychological and physical problems at later stages of their life. The purpose of this study is to reveal the psychotraumatic effects of "Dersim 38" on the second and third generations. This qualitative study sample consist of second (14 people) or third generation(13 people) living in Tunceli and who have Alevism belief. The data of research is collected by using semi-structured form with depth interview method and evaluated with content analysis method. According to the finding of this study, there are important psycho-traumatic effects on both generations. even though many years have passed, emotion focused coping method is still used; third generation has also tried solution oriented coping.
Ein großer Teil der psychiatrischen gutachterlichen Tätigkeit unterfällt dem Gebiet des Sozialrechts. Dabei geht es um die Beurteilung der Dienstfähigkeit oder möglicher psychischer Störungen, die jeweils Grundlage für Renten- und Entschädigungsleistungen im Rahmen des Rentenrechts, des Entschädigungsrechts einschließlich der Unfallversicherung, des Opferentschädigungsgesetzes und privatrechtlicher Entschädigungsansprüche ist. Auch die Begutachtung von Traumafolgestörungen stellt dabei ein praxisrelevantes Thema dar, wobei die posttraumatische Belastungsstörung sicherlich die relevanteste Diagnose bei der Begutachtung von Traumafolgestörungen repräsentiert. Besondere Bedeutung kommt der posttraumatischen Belastungsstörung bei der Begutachtung der Dienstfähigkeit von Soldaten, in Verfahren zum Militärversorgungsrecht und in dem Asyl- und Ausländerrecht zu.
Posttraumatic stress disorder (PTSD) and depression are highly comorbid within the veteran population. Research studies have yielded divergent findings regarding the effect of depression on PTSD treatment outcomes. The present study investigated the influence of pretreatment depression severity on PTSD and depression symptom trajectories among 85 older (i.e., ≥ 60 years) male veterans with military-related PTSD who received either prolonged exposure or relaxation training as part of a randomized controlled trial. Participants were categorized as having no/mild depression (n = 23) or moderate/severe depression (n = 62). The PTSD Checklist (PCL-S) and Patient Health Questionnaire (PHQ-9) were completed at pretreatment, each of 12 therapy sessions, posttreatment, and 6-month follow-up, for a total of up to 15 data points per participant. Multilevel modeling (MLM) was used to evaluate the impact of pretreatment depression severity on piecewise symptom trajectories (i.e., active treatment and follow-up periods) over time and to determine whether treatment condition moderated the trajectories. The final MLM results showed significant main effects of depression severity on PCL-S scores, B = 10.84, p = .043 and PHQ-9 scores, B = 7.09, p = .001, over time. No significant interactions emerged for either the PCL-S or PHQ-9, indicating that although older veterans with more severe depression endorsed higher PTSD and depression scores across time, the symptom trajectories were not moderated by depression severity, treatment condition, or their interaction.
Während Traumafolgestörungen bei jüngeren Menschen in den letzten Jahrzehnten zunehmend Fokus klinischen und wissenschaftlichen Interesses geworden sind, ist das Wissen über Ausmaß und Konsequenzen von Traumatisierungen Älterer weiterhin gering ausgeprägt. Die meisten psychotraumatologischen Studien haben bislang entweder nicht genügend ältere Menschen eingeschlossen, um Alterseffekte beurteilen zu können, oder konzentrierten sich ausschließlich auf jüngere Studienteilnehmer. Dies ist insofern problematisch, als der bisherige Wissensstand darauf hindeutet, dass sowohl altersspezifische Entwicklungsaufgaben bzw. Stressoren als auch kollektive, generationentypische Traumatisierungen zu einer spezifischen Ausprägung und Verarbeitung von Traumafolgestörungen und speziell der posttraumatischen Belastungsstörung (PTBS) im höheren Lebensalter beitragen. Das Kapitel gibt typische Stressoren wieder, die ältere Menschen in sehr unterschiedlichem Ausmaß belasten können.
Recent reviews and treatment guidelines regard trauma-focused cognitive-behavior therapies as the treatments of choice for chronic post-traumatic stress disorder (PTSD). However, many patients do not engage in this treatment when it is available, drop out before completion, or do not respond. Medications remain widely used, alone and in conjunction with psychotherapy, although the limitations of traditional monoamine-based pharmacotherapy are increasingly recognized. This article will review recent developments in psychopharmacology for PTSD, with a focus on current clinical data that apply putative neurobiologic mechanisms to medication use—i.e., a theranostic approach. A theranostic approach however, also requires consideration of timing, pre, peri or post trauma in conjunction with underlying dynamic processes affecting synaptic plasticity, the HPA axis, hippocampal activation, PFC-amygdala circuitry and fear memory.
Research conducted in the early years after the September 11, 2001 (9/11) terrorist attacks in New York, Pennsylvania, and Washington, DC demonstrated adverse psychological outcomes among residents of the United States who were exposed to the attacks both directly and indirectly via the media. However, less is known about the impact of this collective trauma over time. Beginning at the end of December 2006, a longitudinal study of a nationally representative sample of U.S. residents (Cohort 2, N = 1,613) examined the long-term effects of 9/11, with annual assessments administered every year for 3 years. We assessed rates of 9/11-related posttraumatic stress (PTS) annually during the first 2 years of the study; during the second and third years of the study, we assessed fear and worry regarding future terrorism. Rates of PTS among participants were compared with those assessed annually in a nationally representative sample between 2002 and 2004 (Cohort 1); results indicated a relatively stable pattern of 9/11-related PTS symptoms for 6 years following the attacks. Five to six years after 9/11, we found an association between 9/11-related PTS and both direct, B = 8.45, 95% CI [4.32, 12.59] and media-based (live television), B = 1.78, 95% CI [0.90, 2.65] exposure to the attacks. Six to 7 years post-9/11, fear and worry regarding future terrorism were predicted by 9/11-related PTS symptoms that had been reported approximately 5 years after the attacks, B = 0.04, 95% CI [0.03, 0.05]. The psychological legacy of 9/11 was perceptible among many U.S. residents throughout the decade that followed.
Reaktionen auf schwere Belastungen und Anpassungsstörungen stehen in zeitlichem Zusammenhang mit traumatischen Ereignissen oder belastenden Lebensumständen, ohne die die Erkrankungen nicht aufgetreten wären. Die ICD-10 fasst hierunter im Wesentlichen die akute Belastungsreaktion, die posttraumatische Belastungsstörung (PTBS) und Anpassungsstörungen. Therapeutischer Schwerpunkt liegt auf den psychotherapeutischen Verfahren. Bei akuter Belastungsreaktion und Anpassungsstörungen sind stützende Gespräche oft ausreichend. Bei PTBS ist die Wirksamkeit der traumafokussierten kognitiven Verhaltenstherapie am besten und partiell auch die Eye-Movement-Desensitization-and-Reprocessing-Therapie belegt; empfohlen wird ein phasenorientiertes Vorgehen zunächst mit Stabilisierung, dann Traumaexposition. Generell sollte bei Traumata nicht zu früh interveniert werden und nur bei Vorliegen zusätzlicher Risikofaktoren. Es wird von einer routinemäßigen Anwendung des Debriefings nach Katastrophen abgeraten.
Older adults represent the fastest growing demographic of the United States population. However, the elderly are insufficiently represented in studies examining the mental health impact of natural and man-made disasters. Social, cultural, and economic variables influence disaster-related mental health sequelae with a higher risk for morbidity and mortality among older adults due to physiologic factors, associated cognitive underpinnings, and chronic disease burden. Post-disaster mental health symptoms in elderly include sleep disturbance, irritability, acute stress reactions, depression, generalized anxiety disorder (GAD), substance use, and post-traumatic stress disorder (PTSD).
Psychische Folgeschäden nach traumatischen Ereignissen sind sehr häufig. Ullmann und Wind (2004) schätzen, dass etwa 20–25% aller Unfallverletzten eine psychoreaktive Störung entwickeln.
In this chapter, we examine how people adapt in the wake of experiencing psychological trauma. This is called the “longitudinal” (i.e., over a period of time) or “prospective” (i.e., beginning with a particular time or event and continuing into the future) course of posttraumatic adaptation. Traumatic stressors have an impact that is not limited to when they are occurring or the immediate aftermath. Experiencing psychological trauma affects how people adjust and carry on with the rest of their lives, beginning with traumatic events but continuing in the subsequent months, years, and even decades. Like the aftershocks of an earthquake, the impact of traumatic stressors may be felt in many ways for many years, and in ways that are not entirely predictable.
Violence is a public health challenge that affects public health and Public Mental Health. Violence can take many forms at the individual level (e.g. self-inflicted violence, child abuse), the family level (e.g. domestic violence, partner violence), the community level (e.g. community violence) and at groups level (e.g. wars, genocide). Child abuse, self-inflicted violence, domestic violence, partner violence, community violence, wars and genocide not only influence somatic health and incidence and burden of psychopathology. However, the impact of violence on psychopathology remains a contented issue. In this chapter, we aim to review studies on violence and psychopathology within a longitudinal framework. We focus on the impact of violence on depression and anxiety.
Resulting from this review we describe that the impact of violence on depression and anxiety are pervasive, independent of potential well known risk factors such as gender and socioeconomic status. The thorough understanding of the impact of violence on the incidence and burden of depression and anxiety requires a life course perspective. Studies suggest that the impact of violence on psychopathology may be immediate or become apparent many years after the exposure, which has only become possible to ascertain because of the demographic ageing in many countries.
Violence exposure is a main modifiable factor for psychopathology in children, adolescents, adults and older persons. Violence informed Public Health Research and Services are needed to develop and implement tailored interventions.
This comprehensive overview of research and clinical practice in PTSD includes new insights into assessment with regard to DSM-5 and ICD-11, discussion of ongoing controversies in the field as to what constitutes safe and effective care, and new research as to assessment, diagnosis, treatment, and prevention of PTSD. The second edition includes new coverage of the neurobiology of PTSD, PTSD in special populations, and forensic issues relating to PTSD. Synthesizes research and clinical developments on PTSD. Highlights key controversies, issues, and developments in the field. Provides case studies for better understanding of clinical care. Encompasses DSM-5 and ICD-11 major revisions to PTSD symptoms. Includes new coverage of neurobiology and genetics of PTSD. Includes advances in prevention and treatment of PTSD. Includes new coverage of forensic issues related to PTSD. All rights reserved.
Resilience is argued to be relevant to healthy aging. However, resilience studies often fail to examine it in the context of community living. This study is to answer the following question: to what extent is resilience, which is constructed by minority older adults, a contributor to their health status? Through participant observations and interviews with 17 community-dwelling Asian and African American elders of New Orleans (age 60+), this study (a) documents connectedness and social-economic resources among Asian and African American elders; (b) explores how race/ethnicity and immigration experience shapes elders’ view of connectedness; and (c) describes elders’ perception of satisfactory health trajectory, given their capacity to mobilize health care resources. Findings in this study indicate that minority elders maintained engaging relationships with family members and communities. Elders in both populations rated their health status highly positive, appeared strengthened and resourceful, and demonstrated determination and flexibility. However, African American elders self-described more social-economic resources embedded in the community than their Asian peers, primarily because of their strong bonding with the neighborhood. Findings indicate that effective measures (i.e., culturally/community specific) to promote resilience (e.g., connectedness) are likely to have a positive effect on longevity. For minority/immigrant elders, resilience offers a strategy of coping with vulnerabilities. Their resilience seems to rely on culturally specific, collective community identity and resources, thus adding a valuable aspect to the conceptualization of resilience.
Background: With a lifetime prevalence of 8% posttraumatic stress disorder (PTSD) is one of the most common mental disorders; nevertheless, its longitudinal course is largely unknown. Aims: Our aim was to conduct a systematic review summarizing available findings on the prospective, naturalistic long-term course of PTSD and its predictors. Methods: Databases MEDLINE and PsycINFO were searched. Main selection criteria were: 1) naturalistic cohort study with a follow-up period of at least 3 years, 2) adult participants with observer-rated or probable PTSD at baseline. Results: Twenty-four cohorts (25 studies) were retrieved (14 with observer-assessed, 10 with probable PTSD). In total, they comprised about 10,500 participants with PTSD at baseline that were included in the long-term follow-ups. Studies investigating patient populations with observer-assessed PTSD found that between 18% and 50% of patients experienced a stable recovery within 3-7 years; the remaining subjects either facing a recurrent or a more chronic course. Outcomes of community studies and studies investigating probable PTSD varied considerably (remission rates 6-92%). Social factors (e.g. support) as well as comorbid physical or mental health problems seem to be salient predictors of PTSD long-term course and special focus should be laid on these factors in clinical settings. Conclusions: Included studies differed notably with regard to applied methodologies. The resulting large variability of findings is discussed. More standardized systematic follow-up research and more uniformed criteria for remission and chronicity are needed to gain a better insight into the long-term course of PTSD.
Research conducted in the early years after the September 11, 2001 (9/11) terrorist attacks demonstrated that both directly and indirectly-exposed Americans experienced adverse psychological outcomes. However, little is known about the impact of this collective trauma over time. Beginning in December, 2006, a 3-year longitudinal study of a nationally representative sample of Americans (N=1613) examined the long-term effects of 9/11. Rates of posttraumatic stress (PTS) were compared to those reported by a nationally representative sample assessed from 2002-2004; results indicate a relatively stable pattern of 9/11-related PTS symptoms for 6 years following the attacks. 9/11-related PTS was associated with both direct and indirect (live television) exposure to the attacks. Fear and worry regarding future terrorism 7 years post-9/11 was predicted by 9/11-related PTS symptoms 5 years after the attacks. Individuals who reported elevated levels of 9/11-related PTS 5 years after the attacks were the most likely to report PTS following a subsequent collective stressor (the 2008 economic meltdown), controlling for prior distress levels, economic stressors, and economic hardship. The psychological legacy of September 11, 2001 was perceptible among many Americans throughout the decade that followed.
The aim of this study was to assess the long-term impact of war captivity and combat stress reaction on rates of posttraumatic stress disorder (PTSD) in Israeli veterans of the 1973 Yom Kippur war.
One hundred sixty-four former prisoners of war (POWs), 112 veterans who had had combat stress reaction, and 184 combat veteran comparison subjects filled out the PTSD Inventory, a self-report scale based on the DSM-III-R criteria for PTSD. The inventory diagnoses past and present PTSD, assesses its intensity, and provides a symptom profile.
Thirty-seven percent of the veterans who had had combat stress reaction, 23% of the former POWs, and 14% of the comparison subjects had had diagnosable PTSD at some time in the past. The current rates were 13%, 13%, and 3%, respectively. The results showed different recovery rates over time: almost two-thirds of the veterans with combat stress reaction who had had PTSD in the past recovered, while less than one-half of the POW group showed this improvement.
These findings indicate that small but significant proportions of the POWs and veterans with combat stress reaction were still suffering from PTSD almost two decades after the war. The different recovery rates in the two groups may reflect the differences in duration and severity of stressors, the impact of immediate intervention on long-term adjustment, or both.
Three hypotheses regarding symptoms of war-related posttraumatic stress disorder and general psychiatric distress were tested: that symptoms are more severe the more severe the traumatic exposure, regardless of the war in question; that symptoms are less severe the older the veterans' age; and that symptom levels differ across sociocultural cohorts. A total of 5,138 war zone veterans who were seeking treatment from specialized Veterans Affairs outpatient clinical teams made up the sample: 320 World War II, 199 Korean War, and 4,619 Vietnam War veterans. All hypotheses were supported significantly. The similarity of relationships between traumatic exposure and symptoms across wars testifies to the generality of these experiences. Furthermore, the results suggest the operation of significant effects due both to aging and to cohort differences in sociocultural attitudes toward the stigma of mental illness and the popularity of the wars.
The goal of this study was to assess and describe the long-term impact of traumatic prisoner of war (POW) experiences within the context of posttraumatic psychopathology. Specifically, the authors attempted to investigate the relative degree of normative response represented by posttraumatic stress disorder (PTSD) in comparison to other DSM axis I disorders often found to be present, either alone or concomitant with other disorders, in survivors of trauma.
A community group of 262 U.S. World War II and Korean War former POWs was recruited. These men had been exposed to the multiple traumas of combat, capture, and imprisonment, yet few had ever sought mental health treatment. They were assessed for psychopathology with diagnostic interviews and psychodiagnostic testing. Regression analyses were used to assess the contributions of age at capture, war trauma, and postwar social support to PTSD and the other diagnosed disorders.
More than half of the men (53%) met criteria for lifetime PTSD, and 29% met criteria for current PTSD. The most severely traumatized group (POWs held by the Japanese) had PTSD lifetime rates of 84% and current rates of 59%. Fifty-five percent of those with current PTSD were free from the other current axis I disorders (uncomplicated PTSD). In addition, 34% of those with lifetime PTSD had PTSD as their only lifetime axis I diagnosis. Regression analyses indicated that age at capture, severity of exposure to trauma, and postmilitary social support were moderately predictive of PTSD and only weakly predictive of other disorders.
These findings indicate that PTSD is a persistent, normative, and primary consequence of exposure to severe trauma.
The authors examined the longitudinal changes in posttraumatic stress disorder (PTSD) symptom levels and prevalence rates over a 4-year time period among American former prisoners of war (POWs) from World War II and the Korean War. Retrospective symptom reports by World War II POWs dating back to shortly after repatriation were examined for 1) additional evidence of changing PTSD symptom levels and 2) evidence of PTSD cases with a long-delayed onset.
PTSD prevalence rates and symptom levels were measured by the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder. For the longitudinal portion of the study, participants were 177 community-dwelling World War II and Korean POWs. For the retrospective portion, participants were 244 community-dwelling World War II POWs.
PTSD prevalence rates and symptom levels increased significantly over the 4-year measurement interval. Retrospective symptom reports indicated that symptoms were highest shortly after the war, declined for several decades, and increased within the past two decades. Long-delayed onset of PTSD symptoms was rare. Demographic and psychosocial variables were used to characterize participants whose symptoms increased over 4 years and differentiate participants who reported a long-delayed symptom onset.
Both longitudinal and retrospective data support a PTSD symptom pattern of immediate onset and gradual decline, followed by increasing PTSD symptom levels among older survivors of remote trauma.
This study assessed the psychopathological effects of combat in veterans with and without combat stress reaction.
Veterans (N=214) from the 1982 Lebanon War were assessed in a prospective longitudinal design: 131 suffered from combat stress reaction during the war, and 83 did not. They were evaluated 1, 2, 3, and 20 years after the war.
Combat stress reaction is an important vulnerability marker. Veterans with combat stress reaction were 6.6 times more likely to endorse posttraumatic stress disorder (PTSD) at all four measurements, their PTSD was more severe, and they were at increased risk for exacerbation/reactivation. A qualitative analysis of the profile of PTSD symptoms revealed some time-related changes in the symptom configuration of veterans who did not suffer from combat stress reaction. In both groups, the course fluctuated; PTSD rates dropped 3 years postwar and rose again 17 years later; 23% of veterans without combat stress reaction reported delayed PTSD.
These findings suggest that the detrimental effects of combat are deep and enduring and follow a complex course, especially in combat stress reaction casualties. The implications of aging and ongoing terror in impeding recovery from the psychological wounds of war are discussed.
There are currently no longitudinal studies of cognitive performance in older patients with Posttraumatic Stress Disorder (PTSD). It is therefore unclear whether relationships between memory and symptoms differ over time among older persons with and without PTSD.
Twenty-eight Holocaust survivors and nineteen comparison subjects were evaluated 5 years after they had received a memory assessment including paired-associates learning and the California Verbal Learning Test (CVLT).
While Holocaust survivors with PTSD showed a diminution in symptom severity (t = 2.99, df = 12, p = .011), they still manifested a decline in paired associates learning, suggesting an acceleration in age-related memory impairment (related word pairs: t = 2.87, df = 13, p = .013; unrelated word pairs: t = 2.06, df = 13, p = .060). The survivors with PTSD showed improvements on several CVLT measures over time. These improvements correlated with symptom improvements, such that group differences at the follow-up were no longer detected.
The discrepancy in the pattern of performance on these two tests of memory following symptom improvement suggests possible differentiation between of aspects of memory functions associated with aging and trauma exposure and those associated with the severity of PTSD symptoms. Performance on the CVLT appeared related to clinical symptom severity while paired associate learning worsened over time in Holocaust survivors with PTSD, consistent with earlier cross-sectional findings.
We investigated the psychological status and social functioning of Holocaust survivors. From 814 responses to a community survey of Jewish elders (aged 60 years or older), survivors (n = 100), refugees who had not experienced the Holocaust (n = 50), and Australian/English‐born persons (n = 50), were randomly selected for semistructured interview, which included Posttraumatic Stress Disorder (PTSD) assessment, ratings on the General Health Questionnaire, Brief Psychiatric Rating Scale, Impact of Event Scale, Mini‐Mental Status Examination, and Instrumental Activities of Daily Living and Social Functioning. On all psychological measures, survivors were functioning worse than refugees and Australian/English‐born persons. The 3 groups were similar in social and instrumental functioning. The more severe the trauma the greater the level of psychological morbidity. Despite normal social and daily functioning, psychological morbidity following massive trauma endures.
Objective: This study assessed the psychopathological effects of combat in veterans with and without combat stress reaction. Method: Veterans (N=214) from the 1982 Lebanon War were assessed in a prospective longitudinal design: 131 suffered from combat stress reaction during the war, and 83 did not. They were evaluated 1, 2, 3, and 20 years after the war. Results: Combat stress reaction is an important vulnerability marker. Veterans with combat stress reaction were 6.6 times more likely to endorse posttraumatic stress disorder (PTSD) at all four measurements, their PTSD was more severe, and they were at increased risk for exacerbation/reactivation. A qualitative analysis of the profile of PTSD symptoms revealed some time-related changes in the symptom configuration of veterans who did not suffer from combat stress reaction. In both groups, the course fluctuated; PTSD rates dropped 3 years postwar and rose again 17 years later; 23% of veterans without combat stress reaction reported delayed PTSD. Conclusions: These findings suggest that the detrimental effects of combat are deep and enduring and follow a complex course, especially in combat stress reaction casualties. The implications of aging and ongoing terror in impeding recovery from the psychological wounds of war are discussed.
• A test-retest reliability study of the Structured Clinical Interview for DSM-III-R was conducted on 592 subjects in four patient and two nonpatient sites in this country as well as one patient site in Germany. For most of the major categories, ks for current and lifetime diagnoses in the patient samples were above.60, with an overall weighted k of.61 for current and.68 for lifetime diagnoses. For the nonpatients, however, agreement was considerably lower, with a mean k of.37 for current and.51 for lifetime diagnoses. These values for the patient and nonpatient samples are roughly comparable to those obtained with other structured diagnostic instruments. Sources of diagnostic disagreement, such as inadequate training of interviewers, information variance, and low base rates for many disorders, are discussed.
Several interviews are available for assessing PTSD. These interviews vary in merit when compared on stringent psychometric and utility standards. Of all the interviews, the Clinician-Administered PTSD Scale (CAPS-1) appears to satisfy these standards most uniformly. The CAPS-1 is a structured interview for assessing core and associated symptoms of PTSD. It assesses the frequency and intensity of each symptom using standard prompt questions and explicit, behaviorally-anchored rating scales. The CAPS-1 yields both continuous and dichotomous scores for current and lifetime PTSD symptoms. Intended for use by experienced clinicians, it also can be administered by appropriately trained paraprofessionals. Data from a large scale psychometric study of the CAPS-1 have provided impressive evidence of its reliability and validity as a PTSD interview.
The 22-item Philadelphia Geriatric Center (PGC) Morale Scale was subjected to a series of principal component analyses utilizing different item pools and rotating differing numbers of factors. Subjects were 1086 tenants of federally-assisted housing for the elderly and older people living in the community. Results were compared with analyses of the PGC Scale done by Morris and Sherwood. Consideration of factors defined by the analyses suggested three consistently reproduced factors: Agitation, Attitude Toward Own Aging, and Lonely Dissatisfaction, utilizing 17 of the original items. These results were compared with other multi-dimensional measures of morale: the Bradburn Affect Balance Scale, and morale scales reported by Pierce and Clark, and Schooler. In addition to the dimensions derived from the current study related domains of self-rated health, social accessibility, generalized attitude toward aging, and positive affect were suggested as worthy of further exploration as dimensions of morale.
A statewide sample of WWII ex-POWs (N = 442) responded to questionnaires that sampled current and past difficulties with PTSD-related symptoms; an incidence of serious difficulties with these symptoms of 56% was revealed. Retrospective reports of temporal patterns revealed no consistent patterns of symptom occurrence, but, rather, a waxing and waning of difficulties over the 40-year period. Unexpectedly, measures of severity of the POW experiences did not predict current symptomatology. Rank at time of capture, however, was consistently and strongly predictive of PTSD. It is suggested that PTSD is a highly persistent phenomenon and that both situation and person variables contribute to the development and maintenance of PTSD.
The authors performed structured psychiatric examinations of 188 former prisoners of war (POWs). Sixty-seven percent had had posttraumatic stress disorder. Of those affected, 29% had fully recovered, 39% still reported mild symptoms, 24% had improved but had moderate residual symptoms, and 8% had had no recovery or had deteriorated. Presence of posttraumatic stress disorder was not significantly correlated with other mental disorders. Delayed onset was not seen. The findings confirm the DSM-III concept of and criteria for posttraumatic stress disorder.
The authors' objective was to compare the urinary cortisol excretion of Holocaust survivors with posttraumatic stress disorder (PTSD) (N = 22) to that of Holocaust survivors without PTSD (N = 25) and comparison subjects not exposed to the Holocaust (N = 15).
Twenty-four-hour urine samples were collected, and the following day, subjects were evaluated for the presence and severity of past and current PTSD and other psychiatric conditions.
Holocaust survivors with PTSD showed significantly lower mean 24-hour urinary cortisol excretion than the two groups of subjects without PTSD. Multiple correlation analysis revealed a significant relationship between cortisol levels and severity of PTSD that was due to a substantial association with scores on the avoidance subscale.
The present findings replicate the authors' previous observation of low urinary cortisol excretion in combat veterans with PTSD and extend these findings to a non-treatment-seeking civilian group. The results also demonstrate that low cortisol levels are associated with PTSD symptoms of a clinically significant nature, rather than occurring as a result of exposure to trauma per se, and that low cortisol levels may persist for decades following exposure to trauma among individuals with chronic PTSD.
The purpose of this study was to examine the relationships among cumulative lifetime trauma, recent stressful events, and presence and severity of current posttraumatic stress disorder (PTSD) symptoms in Holocaust survivors and nonexposed comparison subjects.
Lifetime trauma, recent stressful events, and presence and severity of PTSD were assessed in Holocaust survivors (N=72) and comparison subjects ( N=19).
Survivors with PTSD (N =40) reported significantly greater cumulative trauma and recent stress than survivors without PTSD (N=32) and comparison subjects. Severity of PTSD symptoms, cumulative trauma, and recent stress were significantly associated.
The presence and severity of current PTSD were related to having experienced stressful events in addition to the Holocaust.
Symptom patterns were compared between Holocaust survivors in concentration camp (n = 70) and those who were in "hiding" (n = 30) during the war. The impact of age at the time of the trauma, gender, and cumulative lifetime stress, and the effect of each of these variables controlling for the others, on posttraumatic stress disorder (PTSD) symptoms were also evaluated. A significant negative relationship between age at the time of the trauma and symptoms of psychogenic amnesia, hypervigilence and emotional detachment, and a positive correlation between age and intrusive thoughts, were observed. Cumulative lifetime stress was positively associated with symptoms of avoidance. The study provides the first empirical data regarding the factors that potentially explain individual differences in PTSD symptom patterns in Holocaust survivors.
The aim of this study was to examine change in the prevalence of psychiatric disorders over a decade late in the lives of ex-prisoners of war (POWs) and nonprisoner veterans of World War II. In 1982-83 we drew a random sample of POWs and non-POWs living in Sydney, Australia. They were interviewed by a psychiatrist at that time and again 9 years later. They also completed self-rating anxiety and depression scales. Anxiety disorders were the most prevalent and declined by half from 32.7% at the first interview to 16.8% 9 years later (p < .001) whereas the prevalence of depressive disorders fell by two-thirds from 26.9% to 8.7% (p < .001). In POWs the prevalence of both anxiety and depression declined more markedly than in non-POWs. Consistent changes also occurred in scores on the self-rating anxiety and depression scales. The psychological impact of these POWs' tragic wartime experience had at last begun to dim after nearly 50 years.
Given important differences in the Korean conflict and World War II, samples of treatment-seeking combat veterans from these wars (30 Korea, 83 World War II) were compared on the prevalence and severity of posttraumatic stress disorder (PTSD). With age, ethnicity, and combat exposure taken into account, the Korean veterans reported significantly more severe symptoms on both interview and self-report PTSD measures. Group differences in the prevalence of current PTSD were in a similar direction but not significant. These results are generally consistent with other studies that have found Korean combat veterans to exhibit higher rates of psychosocial maladjustment than World War II combat veterans. Based on related research with Vietnam veterans, one direction for future investigation is to examine what role stressful postmilitary homecoming experiences may have played in influencing the development and course of combat-related PTSD in the aging cohort of "forgotten" Korean conflict veterans.
Epimeric C-glycoside based polyphosphates, alpha- and beta-D-glucopyranosylmethanol 3,4,1'-trisphosphates (8 and 9) were prepared from D-glucose. The key intermediate, allyl 2,6-di-O-benzyl-alpha-D-glucopyranoside, was prepared in five steps (67% yield) from allyl alpha-D-glucopyranoside without the need for chromatography. Compounds 8 and 9 were shown to be full agonists at the Ins(1,4,5)P3 receptors of permeabilised hepatocytes, but with markedly different potencies. Such C-glycoside analogues are worthy of further development as Ins(1,4,5)P, receptor ligands.
This study examined the longitudinal course of posttraumatic stress disorder (PTSD) among two samples of Dutch aging military veterans: 576 veterans with a military disability pension and 198 community sample veterans, who fought in World War II, the former Dutch East Indies, and Korea. Both samples were investigated in 1992 and in 1998 with a standardized and validated instrument measuring PTSD symptoms. In 1992, 27% of the veterans with a military disability pension met the criteria for a PTSD diagnosis; in 1998, this was 29%. Of the community sample veterans, 9% reported a PTSD diagnosis in 1992, in 1998 this was 8%. The results provide strong support for the long-term persistence of PTSD symptoms. In addition, PTSD caseness at one time point was associated with significantly elevated PTSD symptom severity at the time of no PTSD diagnosis. No evidence was found for an aggravation of PTSD due to stressors associated with aging.
We investigated the psychological status and social functioning of Holocaust survivors. From 814 responses to a community survey of Jewish elders (aged 60 years or older), survivors (n = 100), refugees who had not experienced the Holocaust (n = 50), and Australian/English-born persons (n = 50), were randomly selected for semistructured interview, which included Posttraumatic Stress Disorder (PTSD) assessment, ratings on the General Health Questionnaire, Brief Psychiatric Rating Scale, Impact of Event Scale, Mini-Mental Status Examination, and Instrumental Activities of Daily Living and Social Functioning. On all psychological measures, survivors were functioning worse than refugees and Australian/English-born persons. The 3 groups were similar in social and instrumental functioning. The more severe the trauma the greater the level of psychological morbidity. Despite normal social and daily functioning, psychological morbidity following massive trauma endures.
The long-term health sequelae of the Holocaust were assessed 40-50 years later in the framework of a Jerusalem community health study. Holocaust survivors (N = 288, mean age = 67.6 years) and European-born Jews, not exposed to the Holocaust (N = 486, mean age = 68.9 years), were studied in 1985-87. Our objective was to compare psychobehavioral factors, clinical variables, and mortality outcomes. The comparisons revealed higher emotional distress scores in female Holocaust survivors than in unexposed women and poorer self-appraised health status in male Holocaust survivors than unexposed men. A 10-year mortality follow-up that terminated in April 1996 showed no significant association with Holocaust exposure. Long-term Holocaust survivors may represent a selective resilient group.
This study assessed the degree to which Holocaust survivors have dealt successfully with the eight psychosocial crises thought by Erikson (1959) to mark important stages in life-span development. In Study 1, 50 autobiographical interviews of survivors videotaped 30-50 years after the war were subjected to thematic content analysis. Relevant passages were coded as representing either a favorable or an unfavorable outcome as defined by Erikson. Survivors described significantly more favorable than unfavorable outcomes for seven of the crises; the exception was Trust vs. Mistrust. In Study 2, audiotaped Holocaust survivor interviews conducted in 1946 were scored in the same way and compared with the results of Study 1. There were several significant differences as well as similarities between the two data sets, the later interviews mostly showing changes in the positive direction.
Suicide rates are higher in elderly persons than in those at other phase of the life-cycle. The majority of World War II (WWII) veterans and Holocaust survivors still define their war experiences as being the "most significant stressor" of their lives. Aging of survivors is frequently associated with depression, reactivation of traumatic syndromes, physical disorders, loss, and psychological distress, possibly increasing the risk of suicide. The aim of the present study was to investigate, among a large cohort of elderly Holocaust survivors, whether their WWII experiences confer an increased risk of suicidal behavior.
All medical records of elderly patients admitted to a psychiatric hospital in Israel during a 5-year period were retrospectively evaluated. Suicidal patients were compared with patients who had not attempted suicide.
Of 921 eligible patients, 374 were Holocaust survivors; 135 (14.6%) had attempted suicide in the month before admission. Ninety Holocaust survivors (24%) had attempted suicide, versus 45 of the 502 patients (8.2%) with no WWII experience. The risk of attempted suicide among Holocaust survivors was significantly increased.
Although these findings are from a highly selected sample, we suggest that aging Holocaust survivors are at increased risk of attempting suicide. The growth of the elderly population, of whom many had had traumatic life experiences, emphasizes the need to implement preventive strategies so that suicidal risk may be contained.
The psychological responses to captivity were measured in a sample of former prisoners of war (POWs) 18 and 30 years after release from captivity.
209 Israeli veterans of the 1973 Yom Kippur War (103 ex-POWs and 106 controls) who had taken part in a previous study conducted in 1991 participated in the current study conducted in 2003. The study assessed current rates of posttraumatic stress disorder (PTSD), changes in PTSD over time, and the contribution of captivity severity (objective and subjective), sociode-mographic variables, and psychological appraisal and coping with captivity to predicting PTSD using standardized self-report questionnaires.
Twenty-three percent of the ex-POWs met PTSD criteria and were 10 times more likely than controls to experience deterioration in their psychological condition in the 12-year interval between the 2 assessments. Almost 20% of ex-POWs who did not meet PTSD criteria in 1991 met criteria in the current assessment, in comparison to almost 1% of the controls. Current PTSD was predicted by younger age at the time of captivity, by loss of emotional control and higher subjective appraisal of suffering in captivity, and by a greater number of PTSD symptoms in the 1991 assessment.
It is important to follow up and offer treatment to former POWs. Special attention should be paid to those who lost emotional control in captivity and to those who felt that the conditions of their captivity were severe.
The trajectory of posttraumatic stress disorder (PTSD) and PTSD-related symptoms in relation to aging is not well understood. We previously observed higher levels of dissociation as measured by the Dissociative Experiences Scale (DES) among older Holocaust survivors with, compared to those without, PTSD, though scores on the DES in Holocaust survivors were markedly lower than those that had been reported for younger cohorts. We undertook a longitudinal evaluation of dissociation in Holocaust survivors. Twenty-six Holocaust survivors with current PTSD, 30 Holocaust survivors without current PTSD, and 19 nonexposed were evaluated at the initial evaluation and subsequently 8.11 years later. Repeated measures analysis of variance (ANOVA) on the DES scores from these times demonstrated a significant main effect for time and a significant group by time interaction, reflecting a marked decline in Holocaust survivors, particularly those with PTSD. Controlling for age obliterated the effect of time, but not the group by time interaction. A similar pattern was shown with The Clinician Administered PTSD Scale (CAPS) scores. Different symptoms related to PTSD show different trajectories of change with age, with dissociation appearing to be less prominent with age.
Holocaust survivors, who experienced trauma 60 years ago, provide an opportunity to explore the impact of early lifetime trauma in later life and, in particular, the interplay of depression and posttraumatic stress disorder (PTSD). In this study, the authors contrast depressed Holocaust survivors (HD), nondepressed Holocaust survivors (HND), and older depressed persons (CD).
The sample consisted of 36 consecutive Holocaust survivors (mean age: 79 years) treated in a primary care practice, among whom 20 (56%) were diagnosed as having a major depressive disorder and 16 as nondepressed; 18 depressed non-Holocaust Jewish primary care patients served as controls (mean age: 84 years). The authors examined nine clinical and social variables. The Kruskal-Wallis, Mann-Whitney U, and chi(2) tests were used to contrast the groups. The authors used a conservative significance level of .01.
In contrast to the CD group, the HD group was significantly older, more likely to report PTSD and guilt symptoms, to have higher Beck Anxiety Inventory (BAI) and Brief Psychiatric Rating Scale (BPRS) scores, and to have more impaired social functioning. In contrast to the HND group, the HD group was significantly more likely to report PTSD and guilt feelings, to have higher Hamilton Depression Scale (HAM-D), BAI, and BPRS scores, and to have more impaired social functioning. In contrast to the CD group, the HND group was significantly more likely to have PTSD symptoms and to have lower HAM-D and BPRS scores.
The prevalence of depression and PTSD symptoms were very high among survivors. Depressed survivors had significantly worse psychologic and social functioning than depressed controls. Depressed survivors had more PTSD symptoms than nondepressed survivors, although it is unclear as to the causal direction of the relationship between depression and PTSD.
This study's goal was to develop a measure of late-onset stress symptomatology (LOSS). LOSS is a phenomenon observed in aging combat veterans who (a) were exposed to highly stressful combat events in their early adult years, (b) have functioned successfully throughout midlife with no history of chronic stress-related disorders, but (c) begin to register increased combat-related thoughts, feelings, and reminiscences commensurate with the changes and challenges of aging. Several samples of older male combat veterans from World War II, the Korean Conflict, and the Vietnam War served as participants. We developed a LOSS Scale that demonstrated a high degree of internal consistency reliability (coefficient alpha = 0.97). Scores were stable over brief intervals but were sensitive to developmental change over an extended period. Factor analysis suggested a single LOSS factor. Bivariate associations between LOSS score and other variables (e.g., indicators of contemporary life stressors, resilience, quality of life) were consistent with hypotheses, and there was support for the incremental validity of LOSS vis-à-vis posttraumatic stress symptoms and symptoms of general distress. Discussion of the potential uses of the scale, future directions for psychometric research, and suggestions for generalizing the LOSS construct to other trauma populations are provided.
The authors examined the psychometric characteristics and factor structure of the Civilian Version of the PTSD Checklist (PCL-C; F. W. Weathers, B. T. Litz, J. A. Huska, & T. Keane, 1994) in elderly survivors, aged 66-90, of the 2004 Florida hurricane disasters. Confirmatory factor analyses of nine models of PCL-C structure revealed the strongest support for a 4-factor model consisting of reexperiencing, avoidance, numbing, and arousal dimensions. Future studies will be facilitated by the knowledge that the PCL-C 4-factor model appears to apply across the adult age range and a variety of posttraumatic stress disorder-producing conditions.
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